University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
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Last updated March 21, 2013 8:29 AM

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University Hospital of Wales Heath Park
Cardiff
CF14 4XW
02920 747747

Intubation

Personnel

If urgent intubation and consultant is off-site, call the anaesthetic registrar on bleep 6000 for immediate assistance.

In extreme emrgencies, if the bleep 6000 anaesthetist is unavailble, call the Adult ITU to request immediate assistance.


Two doctors minimum

Kit

Intubation trolley

END-TIDAL CO2 MONITORING IS MANDATORY

Laryngoscopes: > 18 months curved adult MacIntosh 3. <18 months, straight flat blade such as a Seward or Robertshaw or Cardiff blade can be used from birth to adolescence

Tracheal tubes ( The formulas given below are only an estimate and are not a substitute for direct visualization of the tube position at the cords or tube placement on CXR)

Cuffed tubes acceptable for all ages, but cuff pressure must be < 20cm H2O - usually only available for > 4.5mm tubes

Gum elastic bougie

Yankeur suction

Laryngeal mask available

Drugs

Have the following drugs drawn up unless instructed otherwise

Anaesthetic drugs

Propofol 0.1 - 0.2ml/kg
Fentanyl 5mcg/kg IV
Midazolam 0.1mg/kg
Thiopentone 6mg/kg


NMJ blocker
Vecuronium 0.2mg/kg


Gas induction
This may be required for cases with a difficult airway - only set up the machine if you are an anaesthetist.

Notes

Post-intubation CXR mandatory
Only cut the tube after CXR has confirmed position. Do not cut too short in patients who might become oedematous - this will cause the tube to migrate proximally
If the tube needs to be advanced or withdrawn, use sedation and consider paralysis

ETT size Guide

 

ETT diameter

formula

 

 

ETT length at lips

formula

 

 

ETT length at nose

formula

 

 

Laryngeal mask size guide

 


Number

Patient weight (kg)

Inflation volume (ml. Of air)

 

1

 

<5

 

2-5

 

1.5

 

5-10

 

3-8

 

2

 

10-20

 

5-10

 

2.5

 

20-30

 

10-15

 

3

 

30-50

 

15-20

 

4

 

50-70

 

20-30